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Page 1: Certificate-of-Violation-Annual-Review2 on account of any violation which must be listed, he/she shall so certify (Section 391.27). COMPLETED BY DRIVER - CERTIFICATION OF VIOLATIONS

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VIOLATION ADDRESS AND CASE NUMBER VIOLATIONS …...VIOLATION ADDRESS AND VIOLATIONS DEFENDANT (OWNER) (4) #11-11-CE-3817 27157 Washington Street Disposition: Lacombe, LA 70445 CODE